Macular Hole

A Macular Hole, as the term suggests, is a hole which forms at the central macula. It results in decreased vision centrally or a gap in the central vision.

Causes of Macular Hole

A large percentage of macular hole cases seem to develop suddenly without obvious causes. Due to this reason, we are unable to prevent the development and formation of this condition. However, data suggests that individuals above 55 years of age are more susceptible to forming macular holes. Females are also more likely to develop macular holes as compared to males.

External factors such as injury or trauma to the area near the eye or head have been known to lead up to the formation of macular holes.

Certain bodily or eye conditions may also increase the risk of macular hole formation. Diabetic eye diseases have been known to contribute to the likelihood of forming macular holes.

If the patient has a high degree of myopia, over-stretching of the retina or too much traction from the vitreous gel centrally may be a possible cause. Changes in the eye may also be a likely cause. As we age, the vitreous gel that fills the inside of the eye can shrink. As this vitreous gel shrinks, it may effect a certain force on the retinal surface and may cause it to pull away as the gel shrinks. This force is known as “vitreous traction” and sometimes may cause a retinal detachment or a macular hole to form.

Formation of a macular hole in one eye only is common, but in individuals that have formed a macular hole, the likelihood of the other eye developing a macular hole is estimated to be 5-15%.

Macular holes can go away without treatment, but there is significant risk for it to worsen if left alone. Macular holes are classified in 3 stages:

  • Foveal Detachments: Risk to worsen – 50%
  • Partial Thickness Hole: Risk to worsen – 70%
  • Full Thickness Hole: Almost all worsen without treatment.

Symptoms of Macular Hole

Symptoms of a macular hole are manifested in changes in the patient’s central vision and visual acuity.

A patient will commonly observe:

  • Blurring of vision;
  • Distortion in vision – this can cause straight lines to appear wavy or bent
  • Dark spots in the central vision

The severity of the symptoms are entirely dependent on where the macular hole is situated on the macula or retina, its size, and how far the condition has progressed.

What Treatment is effective for Macular Hole?

Typically, a surgical vitrectomy is the recommended treatment for a macular hole surgery treatment. During this surgery, the part of the vitreous gel that fills the interior of the eyeball is partially removed at the point where the macular hole has occurred. This space is then filled with a gas bubble tamponade to allow the hole to close on its own. This method is effective in solving the “pull away” effect when the vitreous gel shrinks, while allowing the macular hole to close.

In certain cases, where the macular hole is very small and when it does not present a significant deterioration of vision, the eye specialist may decide that it is better to postpone or not do macular hole surgery at all, and to leave it to close on its own under careful and strict monitoring. Should this be the case for you, please be reminded that it is of utmost importance to stick to the regular schedule for follow-up appointments. This will allow the eye specialist to ensure that healing at the site is progressing as expected, and if the condition worsens, it is detected and treated at the earliest possible timing.

This would prevent damage to your macula and retina, preserving the quality of vision that would not normally be possible if left untreated.

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